INTRODUCTION AND OBJECTIVES: Recently, retrograde intrarenal surgery (RIRS) is widely being performed for treatment of renal stones with the development of instruments and technique, and its efficacy and safety has been proven in many studies. When we perform RIRS, we usually try to remove stone fragments actively using a stone basket but this procedure can increase the operation time and risk of ureter injury. Herein, we tried to verify the necessity of active stone removal during RIRS, based on our experiences.METHODS: From January 2010 to January 2015, 254 patients underwent RIRS at our institution. We classified these patients into 2 groups according to the performance of active stone removal. Group A included the patients who underwent active stone removal using stone basket during RIRS (n¼177), and group B included the patients who underwent dusting of stones without active stone removal during RIRS (n¼77) Overall success rate, complications and the operation time were retrospectively compared between the two groups. Single surgeon performed all operations using 8.4F flexible ureteroscopy (Olympus, URF-P5) and 200 nm Holmium laser. The success was defined as complete stone free or presence of clinically insignificant residual fragments (<3mm) without any symptoms on non-contrast computed tomography (CT) after 1 month of procedure.RESULTS: There were no significant differences in mean age (56.2 vs. 58.5), male to female ratio (118/59 vs. 47/30), body mass index (24.5 vs. 25.0 kg/m 2 ), mean stone size (11.1 vs. 11.2 mm) and bilaterality (37/177 vs. 12/77) between the two groups. There were also no significant differences in overall success rate, (76.3% vs 66.2%, p¼0.067), operation time (83.7 vs 83.1 minutes, p¼0.896), and complication rate (32.8% vs 31.2%, p¼0.461) between both groups.CONCLUSIONS: RIRS is considered to be effective and safe procedure for the management of small or intermediate-sized renal stones. Excellent success rate can be expected if we crush stone to small fragments enough to pass even without active stone removal.